Term 1 • Year 2 Bristol Med School | Reflection

 

So, I don’t do these much – a solid year has passed since the last one. Well, here I am, giving you my less-than-wise perspective on how I found the last few months. So, it’s rumoured Term 1 of Year 2 is objectively the most leisurely time of your entire medical school experience in Bristol, to which is a statement I do not object – but it’s not saying much compared to everything else.

Let’s skip over explaining all that standard lecture curriculum stuff you can read on the website; what’s differed from Year 1 is that after finishing a lecture-based teaching block studying a particular system in the body (i.e. respiratory, gastrointestinal, renal) lasting between two to three weeks, we all get placed into a hospital in or around Bristol. Our stethoscopes slung proudly around our necks (£90 worth of the hypocritical attitude “Just don’t ask us to properly use it”), it’s the ultimate committal point-of-no-return investment.

I’d really like to point out how it positively warms my heart to watch my medic colleagues take a history and do clinical examinations on actual patients – everybody slowly emerges with their little personality quirks. Like that intimidatingly buff dude who got in Clicendales last year who is actually adorably soft-spoken and displays great open body language. Or that girl always rocking denim overalls you’ve never really properly talked to who unconsciously leans very far forward, engaging far more with the patient. Or the legend card guy on nights out, who consistently makes sure to repeat back the information to put the patient at ease she/he is being actively understood. I’ll even say it’s humbling to being a part of the beginnings of my peers’ medical career – sappy? Yep.

Aside from that, you’d think medical students would find the clinical environment extremely exciting; and don’t get me wrong, we did desperately yearn for those hospital placements after living in E29 (groggily waiting as the clock ticks a few minutes after the scheduled hour before somebody shouts “LECTURE CANCELLED, CHECK YO EMAILS!” which unfortunately happened far too often). However, there was a surprising collective thought a few of my fellow colleagues had about the 3-day formalities:

“I’ve realised people are just…so tiring. Is that bad?”

We’re still figuring it out. Even myself, I found the weekend leading up to ICS Placement was a bit of a dreaded countdown – it’s the culmination of having not finished going through the Respiratory Element and then we’re expected to know Gastrointestinal pathologies for the following Monday; exhaustion from everything else in our lives not medically-related; fear of the much-too-real insight into the lives we will lead in the many years ahead…

I guess it’s some mild form of empathetic burnout – honestly, actually sitting down with patients is always incredibly humbling and we would never be insincere about it. And yet, at the end of the day, you flop onto your bed in bare-below-the-elbows attire with the lanyard uneven around your neck, utterly exhausted. And I swear, if I met somebody new during that period, I would’ve immediately blurted out the preprogrammed “Hi-my-name-is-Holly-I’m-a-second-year-medical-student-etc-etc-etc”

Anatomy was chill as always. Top tip: no matter how weird your question, ask. Really. As long as you use anatomical terms, you can practically ask anything whilst sounding vaguely intellectual – the demonstrators will possibly be the more openminded people you’ll meet, given the niche nature of their job. And even though your friends (you know who you are) are cackling at your sincere curiosity of the science behind certain, ahem, activities, you’ll certainly thank yourself for not needing to do an uncomfortable Google deep-dive without UV protection from the bare exposure to everything but the science.

And now, January exams have ended (before I hightailed into London – what is it with me escaping to that city after tests?) and Term 2 has begun with the highly anticipated neuro (negatively rumour-drenched from older years). A brief review of Week 1 so far? Let’s just say, I’m seriously enticed to do work rather than celebrate my birthday next week.

’til next time.

©TMK

Laughing Gas | Time Capsule Log 💊

I’ve never tried laughing gas. Just never felt the need to; I’ve seen some of my friends intoxicated with the substance, and that’s enough entertainment in itself. But, the history of this party drug is a pretty incredible one – you’ll realise a lot of great inventors are elite masters of self-experimentation (yeah, not me) and this guy is no exception. Let’s get to it.

It began in 1772, when Joseph Priestly first discovered nitrous oxide, and he successfully synthesised it in 1775. Then came along young English chemist and inventor (plus, future president of the Royal Society), Humphry Davy. In October 1798, he joined the Pneumatic Institution in Bristol as the laboratory operator, and for you Bristolians out there, you’ll be extremely proud to know it was there where Davy played around with stoichiometry and delivered the laughing gas of your parties today! Oh, and just for your interest, this organisation was formed to exploit usage of recently discovered respiratory gases for medical practice – thus, the date 1798 is a pretty vital marker for the rapid progress in the discovery of respiratory gas for times to come.

***A lot of the quotes and information below comes from Davy’s “Researches, chemical and philosophical chiefly concerning nitrous oxide, or diphlogisticated nitrous air, and its respiration” (1800). 

Davy was dead keen on determining the effects of inhaling nitrous oxide (“…I resolved to breathe the gas for such a time and in such quantities, as to produce excitement equal in duration and superior in intensity to that occasioned by high intoxication from opium or alcohol.”) With the aid of his assistant, Dr Kinglake, during his first few experiments, he described “a slight degree of giddiness”, “pleasurable feelings” and “sublime emotions connected with highly vivid ideas”. So, Davy began increasing both the dosage and the frequency of the experiments over the next couple months, and he does allude to a potential medical use of nitrous oxide, “The power of the immediate operation of the gas in removing intense physical pain, I had a very good opportunity of ascertaining.” 

Ya boi began inhaling the gas in out-of-work hours by December, and “felt very great pleasure when breathing it alone, in darkness and silence, occupied only by ideal existence”, though remained incredibly diligent in logging his scientific entries. Ugh, nothing sounds more tempting than a long session of optimistic nihilism, ammirite?

Later, he constructed an “air-tight breathing box” where he would sit for hours and hours, inhaling way too much of that addicting gas, and nearly died on several occasions. He began allowing others to partake (what a selfless man) and I highly recommend you read all the entertaining experiences of his acquaintances, friends & family getting high on this hippy crack. All for science, of course. For example, you know talented poet Robert Southney? Dude who wrote “Goldilocks and the Three Bears”, and the epic 1796 poem “Joan of Arc”? Oh yes, he tried out this gas and stated it “excites all possible mental and muscular energy and induces almost a delirium of pleasurable sensations without any subsequent dejection”.  Ayyy, a delirium of pleasurable sensations leading to talking bears who eat porridge! (Jk I don’t want to assume anything, but who knows…)

17w0tj3hnu7qijpg.jpg
Pleasure was so cheap back then

I know I’m making it sound like Davy was a sneak who used the excuse of science as a coverup to enjoy the bouts of pleasure – but honestly, he really did bear medical intentions in mind and was an intelligent guy. Davy was close to recognizing that inhaled nitrous oxide could be valuable for anaesthesia; however, the usage of nitrous oxide at upper class parties and fairs only increased its reputation as a novelty and decreased its respectability as a medical tool. 

So lets just skip ahead and head across the pond to meet our next figure, Horace Wells, who saw the gas as a way of reliving the pain of dentistry in 1844. In fact, he had such great success he got a chance to perform it for a crowd at Harvard Medical School…and no, they weren’t a friendly bunch. Wells extracted the tooth of a complying patient, and there definitely was a lot less pain than usual, but the patient mentioned still feeling some pain – this was enough for the judgemental physicians to boo Wells off the stage, and Wells committed suicide a few years later. Wow, doctors, way to go – what’s the purpose of your occupation, again?

Two more decades until nitrous oxide was used again publicly. Two! Okay, we’re almost there. Well, its reintroduction around 1870 was somewhat permanent, and remained the golden dental anaesthesia until the 1960s. It kept its position in anaesthetics, though not at the forefront; although plenty of physicians use it in their practice to this day, it isn’t really something anyone would admit to because even medical grade nitrous oxide can leave people anaemic and are potentially lethal even in the right amounts. Eek.

Nitrous-Oxide-Chemical-Label-LB-1591-096
MySafetyLabels.com

Nitrous gas has its iffy reputation, but the fact euphoria is mentioned on labels today endures its original recreational usage from over 200 years ago. So, next time, when you’re buying a canister of this stuff at some awesome party, give thanks to your 20-year-old pal Davy doing exactly the same thing 219 years ago.

Sources:

https://eic.rsc.org/feature/nitrous-oxide-are-you-having-a-laugh/2020202.article

https://io9.gizmodo.com/5934877/the-strictly-non-medical-history-of-laughing-gas

https://en.wikipedia.org/wiki/Pneumatic_Institution

http://www.independent.co.uk/news/uk/home-news/how-dangerous-is-laughing-gas-legal-highs-hippy-crack-nitrous-oxide-safety-facts-explained-a7088226.html

http://justsayn2o.com/nitrous.history.html

http://publicdomainreview.org/collections/the-nitrous-oxide-experiments-of-humphry-davy/

http://www.smithsonianmag.com/smart-news/heres-what-it-was-discover-laughing-gas-180950289/

©TMK

Listerine | Time Capsule Log 💊

Listerine did not invent bad breath. Human mouths have stunk for millennia, and there are ancient breath fresheners out there you can read up about. But here’s a nice little story of how Listerine advertisements transformed bad breath from an ordinary albeit awkward personal circumstance into an embarrassing medical condition with heavy implications of social suicide. Treatment that very conveniently was sold by the company themselves.

The History Of Listerine

What: Listerine was invented originally as a surgical disinfectant.

Who: Doctor Joseph Lawrence, inspired by the research of Sir Joseph Lister. Oh, who was Joseph Lister? Well, back in the nineteenth century, “hospital disease” (now known as post-operative sepsis infection) was prevalent; that is, mortality rates post-operation were high despite successful surgical procedures. For example, Lister reported in the Male Accident Ward in the Glasgow Royal Infirmary, between 45-50% of amputation cases died from sepsis between 1861 and 1865. It was in this ward he did his experiments – in line with his earlier research on the coagulation of blood and role of blood vessels in the first stage of inflammation, he had already formulated theories and disregarded the concept of miasma (popular, but not obsolete medical concept, stating diseases were caused by “bad air”). By that time, bacteriologist Louis Pasteur had arrived at his theory microorganisms caused fermentation and disease; thus, Lister’s education and speculations that sepsis could be caused by pollen-like dust compelled him to accept Pasteur’s theory. An amalgamation of his previous research and Pasteur’s theory, he began conducting experiments; he soaked dressings with carbolic acid to cover wounds (an effective antiseptic already used as a means of cleansing foul-smelling sewers). The results were dramatic: surgical mortality rates decreased from 45 to 15% between 1865 and 1869 in the Male Accident Ward. And in 1865, Lister was the first surgeon to carry out an operation in a chamber sterilised by pulverising antiseptic into a fine mist of carbolic acid into the air around the operation. 

Why: So, here comes in an inspired Joseph Lawrence, who made a unique formulation of surgical antiseptic himself in 1879…and in honour of Sir Joseph Lister, called it LISTERINE®. He formed a partnership with pharmacist Jordan Wheat Lambert, creating Lambert Pharmaceutical Company, producing & selling this disinfectant in operating theatres and bathing wounds.

How: …but it was pretty small market. So, to increase sales, its advertised use became extremely varied: a cure for dandruff, a floor cleaner, a hair tonic, a deodorant, and even a cure for diseases ranging from dysentery to gonorrhoea. Okay, so this did put up company revenues. But the Lamberts had another idea in the 1920s. 

They began putting the vaguely medical-sounding term “halitosis” in their advertisements, framing it as a health condition hindering people from being their best. During that era of time, a lot of companies were offering products that could cure every known illness, including catering to the emerging middle class’s social anxieties. I mean, look at this ad below – the sad, unmarried Edna doomed to be a bridesmaid but never a bride just because she has this condition “halitosis”.

sf3591

This marketing campaign was incredibly successful, and over 7 years, revenues skyrocketed to $8 million. And now, we all know Listerine primarily as the antiseptic for oral health & hygiene. This must be one of the best iterations in history of the modern advertising industry creating a problem to sell its solution. Well played, Lamberts.

Sources:

http://www.sciencemuseum.org.uk/broughttolife/people/josephlister

https://www.listerine.co.uk/about

Listerine Was Once Sold as Floor Cleaner

Click to access listerine.pdf

©TMK

Vibrators | Time Capsule Log 💊

I just came back from the 13th International Conference on Thai Studies titled “Globalized Thailand? Connectivity, Conflict, and Conundrums of Thai Studies” in Chiang Mai – my amazing sister presented her LSE dissertation, Thai Youth Sexual Culture: Exploring Representations of Gender and Sexuality in the Thai Controversial Series, Hormones (2013).” If you’d like to read the masterpiece, here’s the link (scroll down to Tammarin Dejsupa and press that PDF logo); there were way too many intelligent words coming out of her mouth, and needless to say, I was immensely proud, but also very confused…

The panel was on sexuality, media & commercialisation – and so, to kind of continue on a similar theme, I decided to dedicate this time capsule log to that by writing about…vibrators.

•••••

There’s a tale that goes Egyptian Queen Cleopatra invented the vibrator; she supposedly had the idea to fill a hollow gourd with angry bees, and the violent buzzing caused the gourd to vibrate…and the rest is history. Or is it?

If you do a quick Google search on the history of vibrators, many will state it was invented by Victorian doctors as a prescribed “pelvic massage” treatment for patients with hysteria to induce “hysterical paroxysm” (read: orgasm) because the medical professionals back then complained about the manual labour being tiresome. It’s a great conversational story, huh? Imagine breaking the ice with “Hey! Did you know, the vibrator was invented to treat women with hysteria because Victorian doctors got tired of manually stimulating them?” And then there’d be shared boisterous laughter, suggestive nudges and comments like “Ugh, tell me about it!”

hysterical.png
Source

The story makes the Victorians sound reserved, that they were oblivious to the art of self-pleasure and never saw pelvic massage as anything other than medicinal. And until the 20th century, it was even more so believed women did not experience sexual desire; to be a lady was to lack sex drive, with a duty to put up with their husband’s sexual needs. It would feed directly into the stereotypical connotations I’m sure most of you have about the Victorians – the whole high prudery attitude resulting in shrouding piano legs and a “Lie back and think of England” kind of mentality.

It’s true that some doctors during that time believed the art of self-pleasure was highly dangerous to your health (check out these painful looking anti-masturbation devices – moment of silence for all the teens during 1840 to 1900). However, Michel Foucault famously critiqued these stereotypes, and in his book “The History of Sexuality” explains the repressive hypothesis: “…that Western man has been drawn for three centuries to the task of telling everything concerning his sex; that since the classical age there has been a constant optimization and an increasing valorization of the discourse on sex; and that this carefully analytical discourse was meant to yield multiple effects of displacement, intensification, reorientation, and modification of desire itself.”1 Basically, as readers, we’ve read into the history of the past three centuries assuming sexual repression. Whether or not you accept this hypothesis, Foucault sparked much academic work exploring the various ways Victorians did indeed openly speak of desire; there are a lot of examples. Victorian attitude towards both male and female sexuality can be seen just as expressive and expansive as it is today – a prime example being the glamorous courtesan of Paris, Cora Pearl, who lived a very erotic life. In fact, Victorian women had a healthy interest in protecting their bodies whilst still enjoying a sexual relationship; Annie Besant’s “Fruits of Philosophy”2 published in 1877, was a guide that listed every single possible contraceptive method available to the Victorian reader, becoming so popular it even reached out to 125,000 Brits in the first few months alone.

So, back to that whole women-with-hysteria-treated-with-massage-and-vibrator-was-invented story. In actuality, it was only a hypothesis by Dr. Rachel Maines, famed sex historian and author of seminal 1999 book, The Technology of Orgasm”. She even said so herself, “Well, people just thought this was such a cool idea that people believe it, that it’s like a fact. And I’m like, ‘It’s a hypothesis! It’s a hypothesis!’. But it doesn’t matter, you know? People like it so much they don’t want to hear any doubts about it.”3 Truth! Even when I began researching about the topic, I thought it was a hoot and a half to tell. But now we know – yes, the vibrator was officially invented in Victorian times, but that is definitely not the full story. Number one, doctors were fully aware what they were doing; keep in mind, people thought real sex was only penetration to male orgasm, and sex education was incredibly limited. I just wanted to make clear Victorians weren’t this prude, unaware society. Number two, the vibrator’s history is much more complicated. Hopefully we can get past the party story version.

So, what’s the actual history of the vibrator, then? Well, we definitely know its origin was very much within the medical setting; the earliest vibrators, as stated by Dr. Maines, “…came out of massage, hand technology for massage.” Not with the intention of inducing orgasm. But other than that, there is vast amount of speculation out there, which in turn further deep-dives into a plethora of ancient obstetrics & gynaecology papers. I particularly enjoyed Helen King’s critical analysis of the history behind therapeutic masturbation associated with “hysteria” – it’s 32 pages long, but 32 pages of such splendidly interesting information citing many dated texts (honestly, worth checking out). However, I attempted to comb through the tangles of speculated knowledge so you don’t have to (but there is still so much out there I haven’t mentioned). Here we go.

The History of Vibrators

We begin with Hippocrates, widely regarded as the Father of Western Medicine (we swore the derivative of his medical oath during the promise ceremony first week of uni). Despite his brilliance, there was a lot about the female body Hippocrates did not grasp – he believed the womb was an actively moving organ that even travelled to the trachea during orgasm, contributing to heavy breathing. The label “hysteria” is never used in early texts, but that weird womb-moving theory Hippocrates thought of is mentioned as a condition called “suffocation of/from the womb”. The womb, he believed, was to blame for “nervousness, fluid retention, insomnia, and lack of appetite”4 Later, Greek doctor Galen, most admired for being a brilliant anatomist ahead of his time and a master of medical philosophy5, proclaimed the symptoms were caused by retention of semen and saw widows as a particularly high-risk group. The cure: herbal remedies, pelvic massage, and even getting married6 (can you imagine getting this as your prescription). Mind you, the concept hysteria hasn’t been mentioned yet.

It persisted through the Middle Ages; treatments still included marriage and pelvic massage, but also “irritating suppositories and fragrant salves”7This treatment continued throughout the Renaissance period, and Nathanial Highmore was one of the first doctors to publicly acknowledge the end result of pelvic massage – the hysterical paroxysm8Orgasms became kind of a socially acceptable treatment for this strange condition that hadn’t been named yet. Whatever the condition was, doctors agreed it included a wide variety of symptoms including nervousness, anxiousness, emotional outbursts, hallucinations, “tendency to cause trouble”, fluid retention, and yes, sexual thoughts/frustration. 

In the 1700s, speculated causes of this condition shifted from the womb to the brain, but it wasn’t until the beginning of the 19th century when the condition was finally labelled hysteria (the Greek word for womb) and was something in need of treatment. The treatment was hysterical paroxysm, horse-riding, and even unpleasant blasting of water on the abdomen.9 Doctors apparently dreaded giving hysterical paroxysms because it was time-consuming, taxed physical endurance, and hand fatigue giving the massages meant they couldn’t always produce the desired result. They pushed for an invention to aid them – thus, here enters the very first vibrator: the Tremoussior, a strange wind-up clockwork contraption invented in France, 1734 (mind you, this was before electricity was invented). Then, in 1869, came along the steam-powered vibrator, “The Manipulator”, invented by American physician George Taylor – however, it was this cumbersome, immovable thing that you constantly had to shove coal in.

Finally, an enterprising English physician, Dr. Joseph Mortimer Granville, patented an electromechanical vibrator during the 1880s, which became greatly popularised and was soon a permanent installation in the doctor’s surgery at that time. It became incredibly popular and soon, battery-powered vibrators were introduced as a household appliance; it was a huge commercial success, becoming the fifth electrical appliance to be introduced into households alongside the kettle, sewing machine, fan, and toaster10.

 

But then the vibrator had its debut in pornography and became unacceptable as a household tool to treat hysteria, labelled prurient rather than respectable. Women could no longer disguise their intentions of buying one, and doctors dropped the devices because of their sexual connotations. Vibrator ads disappeared from consumer media, and lips were sealed shut – that is, until the women’s movement in 1970s. Feminists like Betty Dodson11 made it a symbol of female sexuality, and vibrators became just as popular as before.

As for hysteria – being such an amorphous condition, the diagnosis surprisingly only recently fell from medical grace in American Psychiatric Association’s mental disorders in 1952.12

So there you have it. From womb-moving theories to feminism, that is how a medical cure became a female sexual icon.

Sources:

1: https://g.co/kgs/Z5hx6H

2: https://www.gutenberg.org/files/38185/38185-h/38185-h.htm

3: http://bigthink.com/ideas/18073

4: http://women.timesonline.co.uk/tol/life_and_style/women/article4032852.ece

5: http://www.greekmedicine.net/whos_who/Galen.html

6: http://www.vonnaharper.com/history-of-the-vibrator.html

7, 8: http://www.motherjones.com/media/2012/06/hysteria-sex-toy-history-timeline/

9: Cosmacini G.  The long art: the history of medicine from antiquity to the present. 00. Rome: Oxford University Press; 1997.

10: http://www.thedailybeast.com/hysteria-and-the-long-strange-history-of-the-vibrator

11: http://www.abc.net.au/news/2016-10-15/the-history-of-the-vibrator/7925988

12: https://www.scientificamerican.com/article/the-vibrator/

©TMK

Coca Cola | Time Capsule Log 💊

I hope you’ve all enjoyed the Six-Word Stories I’ve been putting out! I’m now beginning a new segment called “Time Capsule Log”, which I’m extremely excited about. I’ll be exploring inventions & breakthroughs with weird origin stories, whether it be failed pharmaceutical drugs eventually fated for non-clinical use or accidental products that have ended up medically successful. Curiosity is one of the great virtues of mankind, and it just goes to show purpose doesn’t have to be born out of intention. Alrighty, enough introduction – onto the fun!

The History of Coca-Cola

What? Coca-Cola was initially formulated as a cure for morphine addiction. What!?

Who? John Pemberton was a pharmacist and “the most noted physician Atlanta ever had” according to Atlanta newspapers1, but he was also a Confederate veteran of the Civil War.

John_Pemberton.jpg
John Pemberton. Source: https://en.wikipedia.org/wiki/John_Pemberton

Why? He was almost killed fighting in the Battle of Columbus in April 1865, and with his background as a pharmacist, his access to morphine and need to appease the pain from his war injuries lead to a strong morphine addiction2.

How? In 1884, Pemberton began experimenting to create opium-free medication as an attempt to cure his addiction, and along the way, another doctor claimed coca (cocaine) had the ability to do so. Thus, Pemberton devised “French Wine Coca”, a concoction containing coca leaves, caffeine-containing kola nuts, and wine. The product was advertised dramatically as seen on the label below (well I’ll be; it cures heart disease!). However, the city of Atlanta enacted legislation bringing about local prohibition in 1886, and Pemberton was forced to remove the alcoholic element from his formula, despite selling it as a medicine. Thus, he had to revise his to-be popular beverage by using sugar syrup to replace the wine’s sweetness and carbonating the mixture, eventually marketing it as the Coca-Cola we all know and love today. This new drink was advertised as “delicious, exhilarating, refreshing and invigorating” whilst retaining “the valuable tonic and nerve stimulant properties of the coca plant and cola nuts.” The cocaine ingredient persisted, however, only until the beginning of the 1900s because a series of stories spread throughout the South that black men were getting high on cocaine before raping white women (yikes!)3.

In such devastating irony, despite claims made about Coca-Cola’s restorative powers, Pemberton remained addicted to morphine; he never realised the long-potential of the beverage he created, slowly selling off the company in pieces to various partners before dying of stomach cancer in 1888.4 It is said that on the day of Pemberton’s funeral, the owners of all the drug stores in Atlanta attended the services as a tribute of respect, and “not one drop of Coca-Cola was dispensed in the entire city.”5

I’ve always admired how Coca-Cola holds these joyful campaigns that celebrate authentic, genuine moments in life. Perhaps Pemberton couldn’t cure his own morphine addiction, but he created something pretty beautiful out of it. Lest we forget, let’s clink together a couple of Cokes and say cheers.

Sources:

1: http://www.georgiaencyclopedia.org/articles/business-economy/john-stith-pemberton-1831-1888

2, 3: https://books.google.co.th/books?id=dFRd2MMrtiUC&pg=PA152&lpg=PA152&redir_esc=y&hl=en#v=onepage&q&f=false

4: https://www.amazon.com/God-Country-Coca-Cola-Mark-Pendergrast/dp/0465054684/ref=sr_1_1?s=books&ie=UTF8&qid=1388434759&sr=1-1&keywords=0465054684&tag=bisafetynet-20

5: http://www.georgiaencyclopedia.org/articles/business-economy/john-stith-pemberton-1831-1888

©TMK

I Wore A Heart Monitor For 24 Hours

Spoiler: I’m okay for now.

Approximately three weeks ago, I went for my regular health-checkup routine. There was nothing spectacularly negative about my results – my total cholesterol level increased compared to last year, but it was due to an elevation in good ol’ HDL; my TSH level was 1.960 uIU/mL, smack-bam in the middle of the hospital’s normal range; my hematocrit percentage, usually presented with a taunting “L”, was surprisingly normal for the first time in years. It’s safe to say, living on my own in Bristol the past year has made me much healthier on the micro scale.

Ah, but the results came with a little more excitement than anticipated.

Last year, my EKG result stated: “Sinus bradycardia with sinus arrhythmia; borderline prolonged QT interval; otherwise no pathological findings”. It wasn’t necessarily denial, but an unimpressive knowledge about ECG/EKG interpretation that allowed me to shrug nonchalantly about the situation. But this year, my EKG result stated: “Sinus bradycardia with junctional escape beat and bigeminy premature ventricular complexes”, and after having crammed an outrageous amount of information about various cardiovascular system abnormalities (I’m panicking as the phrase “Quick lids flecking at amiable dilettantes” scrolls across my vision), well, what can I say…I still shrugged nonchalantly about the situation.

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14/06/17 EKG Results (For You Keeners Out There)

A follow-up was required a couple weeks later. I was *this* close to napping face-down all day listening to the ironically motivational movie soundtracks of Rupert Gregson-Williams, but thankfully dragged my lazy bum off the bed due to post-exam hopelessness (I hope today all you IB kids got the results you wanted – remember, there’s always a pathway for you!). So there I was, in the doctor’s office – not to be worried about at all, she said. It’s common for people under 40, and it’s very rare for it to be serious. Two things would happen: I’d get an echocardiogram done, and then wear a Holter monitor for 24 hours.

I remember watching one of the demos talk about echocardiography during an anatomy session, and this image was put up:

echocardiogram
Source: http://www.cardiachealth.org/sites/default/files/2011/echocardiogram.jpg

Um. I mean, what a truly wondrous photo. Find a person who’ll look at you the same way the patient and sonographer look at each other, am I right? (I swear I learn in anatomy sessions).

Anyways, that didn’t happen in my case (painfully grateful); I faced away from the sonographer and counted the number of vertical stripes per coloured block on the wallpaper (seven, if you wanted to know), and there was barely any talking. Despite being half-nude and having this transducer basically kneading my left boob, it all felt incredibly systematic. I almost fell asleep. But by hearing sudden spitfire beatboxing by my heart, occasionally being asked to hold my breath, and catching a glimpse of the Doppler echocardiography’s explosion of pretty colours, I just managed to stay awake.

After swiping away the ultrasound gel, I was then suited up with the Holter monitor: five electrodes plastered on, and a little pouch that held the ambulatory device itself. It’s basically just a piece of tech that records heart activity continuously for 24 hours (or 48, depending on the doctor’s suspicions of the final diagnosis) – since ECG/EKGs are performed only within a short snapshot of time and abnormal heart rhythms/cardiac symptoms come and go, the monitors are pretty great for doctors to evaluate irregularities, severity and patterns over an extended period.

I left the hospital feeling like an amateur espionage agent (watch out Agent Cody Banks!1!!). Here are a couple of images to show the Holter monitor itself and where the electrodes were placed – the former displays a countdown of the exact amount of time I had left of the 24 hours, and shut down once it reached zero; it was like a microcosm of every dystopian novel ever. 

So comes the next day, after having slept as still as a log (subconsciously afraid I’ll roll onto the Holter monitor and suffer the pricey consequences), and they go analyse the data. Here are my results in brief.

Echocardiography Summary: function and anatomy normal albeit mild tricuspid regurgitation (TR). Seeing the real-time videos of my heart beating made me oddly vulnerable – I mean, if you think about it, nobody will ever have the privilege to set eyes on your beating heart (with the exception of those lucky enough to partake in open heart surgery). I’d feel more naked posting a snippet of the echocardiogram than a revealing swimsuit photo of myself.

Holter Monitor Summary: The doctor said if I had 10% or more ventricular ectopic beats in the total number of heartbeats in the 24 hours, I would be sent for treatment. If it was 5% or below, I’d be alright. Luckily, I only had 4.1% – whilst she did appease my mother by stating there was nothing to worry about (“All you need to hear is that her heart is completely normal”), she turned to me and asked me to be more aware of my body. That is, if my palpitations become more frequent or if the tight squeezes I feel in my chest increase in severity, I am to go back to see her.

“How many hours of sleep do you get?” she asked in the middle of history-taking.

“Well, 7 hours on average, now that it’s summer.” I think back to how my heart rate was only 48BPM just before the appointment; that armchair was really quite comfortable…

With a small smile, she casually said, “Ah, wonderful – when you get to clinical years of medical school, you won’t get nearly as much!”

Honestly, I really like this doctor.

Anyways, I got this incredibly exciting full report with an hour-by-hour analysis (I can sense what a funky, wild Friday night I’ll be having).

You can see how the number of PVCs vary during various times of the day; a few examples of the activities I was engaged in included:

8:00PM = delicious dinner at MK with the family + a McDonalds cone (the simple pleasures of life)

10:00AM = extremely fervent Kyle Landry piano-playing; I even got a cramp in my left hand (watch this space for a cover…)

3:00PM = serious car talks in traffic

It’s extraordinary to actually see the direct play between the physical environment and the electrical activity of my heart – the times with high PVC frequencies correlated with some form of intense emotion; “Strike fear into the hearts of your enemies” “With a sinking heart” “Eat your heart out” idioms suddenly became exceptionally reasonable to me. It should be blatantly obvious that everything you do cascades upon your inner mechanics, but I previously could only resonate so much so as if watching a devastating BBC News segment from the comfort of my own home. It just further highlighted the stark opposition of medicine being both routine practice and blindly grasping in the dark.

At the end of the day, the treatment literally stated “reassurance” – drink lots of water, sleep for a minimum of 6 hours per day, no caffeine, stress less. Such basic courses of action to take, and yet so subconsciously overlooked by the generation of today. Anyways, I think as a medical student, having the opportunity to personally experience particular examinations/procedures you see portrayed via cringe-worthy stock photo compilations in lectures provokes the same level of excitement you have as you are about to watch one of the most anticipated block-buster films of the year (I am at this very minute on the way to watch Spider-Man Homecoming). And that’s probably the very reason I documented it all…I guess I’m just young at heart.

©TMK